The word "intervention" still calls up a living room ambush: family in a circle, letters read aloud, a bag packed by the door. That image comes from the confrontational Johnson model, and it's close to the opposite of how addiction work is done now. Current addiction intervention is mostly quieter: screening, conversations that lower defensiveness, matching the approach to how ready someone actually is, and keeping people alive and engaged long enough for change to take hold.
Exam questions on addiction reward those same instincts. Here's a working map of the main techniques and how to choose among them.
Every technique below depends on a clear picture of what's going on. In DSM-5-TR, substance use disorders share 11 criteria that cluster into impaired control, social impairment, risky use, and pharmacological signs (tolerance and withdrawal). Severity depends on how many criteria are met within a 12-month period: two or three is mild, four or five is moderate, and six or more is severe.
Two details are easy to miss. Tolerance and withdrawal don't count toward the diagnosis when they result from medication taken as prescribed, so a patient on prescribed opioids for pain doesn't meet criteria on those signs alone. And the remission specifiers have defined windows: early remission means no criteria other than craving for at least 3 but less than 12 months, and sustained remission means 12 months or longer.
Assessment also means noticing defenses. Denial, minimization, rationalization, and projection are common, and they're information about where the client is, not walls to break through. Confronting them head-on tends to strengthen them.
Before picking a technique, figure out where the client is. The stages of change from Prochaska and DiClemente's transtheoretical model give the framework: precontemplation, contemplation, preparation, action, and maintenance. Relapse is treated as a common part of the cycle, not proof that treatment failed.
Each stage calls for different work. In precontemplation, the job is rapport and raising awareness, not action plans. In contemplation, the client is ambivalent, so the work is exploring both sides of that ambivalence. Preparation is for concrete planning and choosing among options. Action calls for skills and support. Maintenance centers on relapse prevention.
A typical mismatch in a vignette: an action-stage intervention, like a treatment referral or an abstinence contract, offered to someone who doesn't yet think there's a problem. That answer looks responsible. It's usually wrong.
Motivational interviewing is the conversational approach most closely tied to addiction work, and its logic applies to exam questions even when it isn't named. It's a collaborative, guiding style built on partnership, acceptance, compassion, and evocation, meaning the reasons for change are drawn out of the client rather than supplied by the social worker.
The core skills go by the acronym OARS: open questions, affirmations, reflections, and summaries. Reflections do most of the heavy lifting. The social worker listens for change talk (the client's own statements about wanting, needing, or being able to change) and reinforces it, while responding to sustain talk without arguing.
What older literature called "resistance" is now framed as discord in the relationship or sustain talk from the client. Either way, the response is the same: don't push back. Pushing back triggers the client to defend the status quo. MI names the urge to correct and persuade the "righting reflex" and treats resisting it as a core skill.
Developing discrepancy means helping the client notice the gap between their values and their behavior. Decisional balance explores the pros and cons of both changing and not changing.
Scaling questions ask the client to rate importance or confidence from 0 to 10, followed by "Why a 4 and not a 2?" Asking why the number isn't lower invites the client to argue for change. Asking why it isn't higher invites them to argue against it.
MI doesn't rule out sharing information, but it changes how. Elicit-provide-elicit means asking what the client already knows, offering information with their permission, and then asking what they make of it. Unsolicited advice and education delivered into a defensive moment tend to backfire.
MI also works with mandated clients. A client ordered into treatment by a court or employer can still be engaged around their own goals, starting with something as simple as what they'd like to get out of the requirement.
Screening, brief intervention, and referral to treatment is a public health model designed for settings like primary care, emergency departments, and schools, where most people with risky use will never walk into a specialty program.
Screening uses short validated tools such as the AUDIT or AUDIT-C for alcohol, the DAST for drugs, CAGE as a quick alcohol screen, and the CRAFFT for adolescents. A positive screen leads to a brief intervention, often a single MI-informed conversation that offers feedback and explores the client's own goals. Clients with more severe use get a referral to specialty treatment.
The model's logic is proportionality. Not every positive screen needs a treatment program, and not every person who drinks too much meets criteria for a disorder.
CBT for substance use starts with a functional analysis: what happens before use, what the person thinks and feels, what they get out of using, and what it costs them. From there, treatment builds coping skills, drink or drug refusal skills, and strategies for managing cravings.
Marlatt's relapse prevention model adds several testable concepts. High-risk situations are the people, places, emotions, and circumstances that make use more likely. A lapse is a single slip; a relapse is a return to the previous pattern.
The abstinence violation effect describes how a person who lapses may conclude "I've already blown it" and keep using, so treatment works to reframe a lapse as information rather than failure. Seemingly irrelevant decisions are small choices, like driving home past a favorite bar, that gradually set up a high-risk situation.
Mindfulness-based relapse prevention builds on this with practices like urge surfing, where the client observes a craving rise and fall without acting on it.
Contingency management applies operant conditioning directly: clients earn tangible rewards, such as vouchers or prize draws, for verified abstinence, typically confirmed by negative drug screens. It has a strong evidence base and is especially relevant for stimulant use, where medication options are limited.
The community reinforcement approach widens the lens. Instead of only reducing the rewards of using, it works to make a sober life more rewarding through employment, relationships, and recreation that compete with substance use.
Its family-focused variant, community reinforcement and family training (CRAFT), teaches family members to reinforce non-using behavior, communicate without blame, stop shielding their loved one from the natural consequences of use (what's often called enabling), and invite them into treatment at moments of openness.
CRAFT has stronger research support for getting resistant individuals into treatment than confrontational interventions do, and it also attends to the family member's own wellbeing.
Social workers don't prescribe, but they need to know what medications do and to support clients who use them.
For opioid use disorder, the main options are methadone, a full agonist dispensed through specialized opioid treatment programs; buprenorphine, a partial agonist that can be prescribed in office settings; and extended-release naltrexone, an antagonist that requires the client to be opioid-free before starting.
For alcohol use disorder, options include naltrexone, acamprosate, and disulfiram. Disulfiram works by producing a severe physical reaction if the person drinks, so it depends on the client's informed consent and commitment to abstinence. It's a deterrent, not a treatment for craving.
Medication-supported recovery is recovery. A social worker who tells a client on buprenorphine that they aren't "really sober" is imposing personal values over evidence and the client's own choices.
Harm reduction meets people where they are: naloxone distribution, safer use education, and reducing the damage of use for people not ready or willing to stop. It fits squarely within the client's right to self-determination under NASW Code of Ethics standard 1.02. On the exam, an answer that refuses to work with a client until they commit to abstinence is rarely the best one.
Peer support groups remain a major part of the recovery landscape. Alcoholics Anonymous and Narcotics Anonymous follow the twelve-step model. SMART Recovery offers a secular, skills-based alternative grounded in cognitive-behavioral principles. Al-Anon and Alateen support family members.
Twelve-step facilitation is a structured, time-limited professional intervention that encourages active involvement in twelve-step groups. It's distinct from the groups themselves, which are peer-run and not treatment.
The exam-relevant point is fit and choice. A client who objects to the spiritual framing of twelve-step programs should be offered alternatives, not pressured to attend.
Some situations require medical attention before any counseling technique matters. Withdrawal from alcohol and benzodiazepines can cause seizures and delirium and can be fatal, so a client who drinks heavily every day and plans to quit cold turkey needs medical evaluation first. Opioid withdrawal is intensely uncomfortable but rarely life-threatening on its own; the bigger danger comes afterward, when lowered tolerance raises overdose risk if the person returns to use.
Level of care decisions in addiction treatment commonly rely on the ASAM criteria, which assess multiple dimensions, including withdrawal risk, medical and psychiatric conditions, readiness to change, relapse potential, and the recovery environment. The general principle is the least restrictive setting that safely meets the client's needs.
For clients with co-occurring mental health and substance use disorders, integrated treatment that addresses both at once is the standard. Telling a client to get sober before addressing depression or trauma is the outdated sequential approach.
Addiction vignettes ask for judgment more than recall, and a short sequence of checks resolves most of them.
Safety comes first. Withdrawal risk, overdose risk, suicidality, and any other immediate danger get addressed before anything else, and an answer that skips past them is wrong regardless of how good its technique is.
Next comes assessment, including the client's stage of change. If the vignette hasn't established what's going on, gathering that information usually beats intervening.
Then the technique should match readiness. Confrontation, lecturing, and labeling ("You're an alcoholic") are almost never the best response, even when the client is clearly minimizing.
Finally, the client's goals count. Harm reduction and medications are legitimate parts of treatment, not compromises, and goals short of abstinence deserve respect.
Confidentiality questions follow their own logic. Records from federally protected substance use disorder treatment programs can carry heightened confidentiality protections beyond ordinary clinical records. In any setting, though, questions involving family members, employers, or courts asking about a client's treatment usually point toward obtaining the client's written consent before sharing anything. NASW standard 1.07 governs the broader ethical duty.
A social worker in a primary care clinic meets with a client whose routine screening shows risky alcohol use. The client says, "Everybody at work drinks like this. I'm not an alcoholic." What should the social worker do NEXT?
A. Reflect the client's perspective and ask what, if anything, concerns them about their drinking
B. Explain the health risks associated with the client's screening results
C. Refer the client to an intensive outpatient program
The client is defending the status quo, which signals precontemplation or early contemplation. Leading with health risks, as in B, isn't wrong in itself, since feedback is part of a brief intervention. But delivered right after a defensive statement and without asking permission, it tends to provoke more sustain talk. Elicit-provide-elicit puts the client's own view first and offers information with permission. C skips several steps: a single positive screen and an unready client don't call for an intensive program. A reflects without arguing and opens space for the client's own concerns to surface, which is how a brief intervention begins.
The correct answer is A.
Knowing the techniques is one thing. Recognizing which one a vignette is asking for, under time pressure and with plausible distractors in front of you, takes practice. SWTP's full-length practice exams include addiction scenarios across the range covered here, with rationales that explain why the best answer beats the runner-up. Start practicing with SWTP.
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